Effect of a pharmacist-education initiative on ketorolac use and costs in a Medicaid program.

The effects of a pharmacist-education initiative on the use and costs of ketorolac in a state Medicaid program are reviewed. An intervention letter describing changes in the manufacturer's prescribing guidelines for ketorolac and providing suggestions for interacting with physicians regarding the use of ketorolac was sent to 150 of the 301 pharmacies that participate in New Mexico's Medicaid program. The remaining 151 pharmacies served as a control group. Ketorolac claims records for three months before and after the intervention were reviewed. The mean quantity of ketorolac tablets, total days' supply, and number of prescriptions filled per pharmacy per month were calculated for both periods. The number of prescriptions not filled as a result of the intervention as well as the number that could have been avoided, the number of cases of peptic ulceration (ketorolac's major adverse effect) that would be avoided, and the associated cost savings if all the state's Medicaid pharmacies had been included in the intervention were estimated. A total of 167 pharmacies (90 intervention and 77 control) dispensed ketorolac for Medicaid patients during the study period. Ketorolac dispensing rates declined during the postintervention period in both the intervention group and the control group, but the reduction was greater in the intervention group. It was predicted that if all pharmacies were included in an intervention, 135.6 fewer prescriptions for ketorolac would be filled each year; as a result, 1.14 cases of peptic ulceration would be avoided and net Medicaid costs would be reduced by $1638. Sending educational letters to pharmacists was associated with a modest reduction in ketorolac use in a state Medicaid program; a net reduction in Medicaid costs if the intervention were extended to all pharmacies that participate in the state's Medicaid program was projected.

Response forms reflect pharmacists' participation in retrospective DUR.

This study examined pharmacists' responses to two different Medicaid retrospective therapeutic interventions (excessive use of beta 2-agonist inhalers and long-term use of sedatives) in New Mexico. It also examined the types of actions pharmacists reported taking, and the differences between actions taken by physicians and pharmacists in terms of response rate, tone of responses, and time spent responding to the intervention. The most frequent pharmacist action was to call the physician. Response rates for the drug use review (DUR) program were higher for physicians than for pharmacists; pharmacists also took twice as long as physicians to respond to both interventions. The study results indicate a need for better methods to document clinical services performed by pharmacists under the Medicaid DUR program to obtain reimbursement and justify therapeutic decisions. Pharmacists also need documentation methods that are relatively easy to use so that they can respond more quickly to interventions.